Mannitol with edema of the brain
Traumatic cerebral edema
Cerebral edema in severe trauma in acuteperiod has its own characteristics. If the trauma of mild and moderate severity, the clinical picture of the edema usually develops after 1_2 days, then with severe trauma the edema begins almost from the first minutes. As a rule, the edema diffuse, captures both the large hemisphere and the trunk. In the neurological picture, as the edema builds up, all the symptoms associated with a brain contusion can be observed. Edema of the cerebral hemispheres is manifested primarily by pyramidal and extrapyramidal symptoms. With the increase of the brainstem edema, the diencephalic syndrome is first detected or strengthened: hyperthermia develops, respiration is increased to 40-60 beats per minute, the breathing rhythm changes according to the diencephalic type, the pulse is increased to 120-150 per minute, the arterial pressure rises. Then the symptoms of the midbrain deepen: the pupils' reactions to light diminish or disappear, the divergent strabismus appears or increases, the symptom of Magendi is discovered, and the floating movements of the eyeballs appear. Sometimes convulsions such as decerebrate rigidity develop. Edema can lead to the dislocation of the trunk and its infringement in the tentorial and large occipital orifice, which further strengthens the symptoms from the middle and medulla oblongata.
The above complex of symptoms with swellingThe brain is similar to that which often develops in the presence of intracranial hematoma. However, differential diagnosis between cerebral edema and intracranial hematoma is possible. It is believed that the difference between them is that with the edema of the brain all the signs develop milder than with hemorrhage. With edema of the brain, sometimes a Weiss-Edelman symptom appears (with the extension of the leg in the knee joint, a spontaneous Babinsky symptom appears on the same or opposite extremity). With edema of the brain on the side of the paretic limbs, there is early edema of the nipple of the optic nerve. After dehydration therapy (urea, mannitol), the patient's condition often improves with swelling. Some improvement from dehydration can also occur with the formation of a hematoma, but a few hours after it occurs a sharp deterioration, which requires urgent surgical intervention.
In those cases where it is difficult to solve the problem, with whatthe deterioration of the patient's condition, with the formation of a hematoma or with cerebral edema, puncture of internal jugular veins with measurement of venous pressure and the determination of oxygenation of the blood can be performed, and later the contrast methods of research - angiography, diploid sinusography or pneumoencephalography. If the patient's condition is extremely severe and contrast X-ray examination is impossible, the imposition of diagnostic milling holes is shown.
In some cases,limited edema of the brain. It manifests itself in the gradual progression of those symptoms that have been detected since the first days of the injury, as a result of a bruise. So, the elements of sensory or motor aphasia can go into complete aphasia, a light paresis of the arm or legs - into the plethysy, etc. Deterioration usually develops on the 1-5th day after trauma, and sometimes on M-11-e, as a result of the second wave of edema. Temperature, respiration, pulse usually remain without significant changes. Analysis of cerebrospinal fluid does not reveal pathology, if there was no subarachnoid hemorrhage, but its pressure may be increased. Under the influence of dehydrationI) Early exercise, cerebral edema rapidly decreases. If dehydration therapy is applied at a later date, then the restoration of functions is slower.